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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® P.O.?!1P.O. Box 1179
REGISTRAR OF VITAL STATISTICS T't; Southold, New York 11971
MARRIAGE OFFICER ® O .�1 Fax (516) 765-1823
,\V �r Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
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Permit No. 806 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10'0" MAXIMUM BETWEEN OLD AND PROPOSED
NEW POOL. EXCAVATION INSPECTION REQUIRED. CALL THE BUILDING DEPART-
MENT (765-1802) FOR AN APPOINTMENT.
Name Of Owner POLATN I CK, JEROME
Mailing Address 1 1310 CRITTENS LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 1310 CRITTENS LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 12 lot 7.000
Cross Street PARKWAY
Building Permit Number Cross Reference:
Issue Date: 2/12/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY j ". Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS J� : Southold, New York 11971
MARRIAGE OFFICER '-*:(0/ �- .V.4�� Fax (516) 765-182365-1
_ //rr.�� A_, .*` Telephone (516) 765-1801
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OFFICE OF THE TOWN_CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office -
Dated: February 11, 1992
Transmitted herewith is a copy of application No. AR27 for a Cesspool/
Septic Tank Construction Permit submitted by:
Morris Cesspool for Jerome Polatnick .
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
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I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE
Comments: q, ,Ecot.S a n o,taag. c "c..A . N�
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Signature
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OFFICE OF THE TOWN CLERK F fo`K •.,
Town of Southold �,"' _ h
Town Clerk �� ®l/ Application No of
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Judith T. Terry, , y
Town Hall, 53095 Main Road ;� f }
Construction
P. O. Box 1179 /� : Alteration
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Southold, New York 11971 ,
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Telephone �'y® �® oo' $10.00 - Residential Y.
(516) 765-1801 _ 1 ,, 0' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL s
Permit No. •
Fee $ i •
DATE f �4 192
• ,
APPLICANT NAME: ,/o/e r �'C.SSpdo f C�p/I e
APPLICANT ADDRESS: 27?6 f/ "'in2/9i /A?
Shu /44)d 4 t
SEPTIC ;' CESSPOOL\?
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: �lc,C.co,,, j /4... //'7, CX
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OWNER MAILING ADDRESS: /j) /O 62 ,'2L7/:./1/ 461
OWNER PROPERTY ADDRESS: 1 .__QA~
TELEPHONE NUMBER OF CONTACT PERSON: \k-.7.fdd
TAX MAP NO. : Section 70 Block / Lot 7
CROSS STREET: ��'4
BUILDING PERMIT NUMBER CROSS R FERENCE:
/4/44,3
Signature of Applicant
RECEIVED
55 RECEIVED BY:
FEBiorlvrf rk's Office
• DATE:
, .: Southold Town Clerk-
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